EMM System Design Considerations
For The Clinician-System Interface
Connie Lo
eMM Application Specialist
Michael Turner
eM...
Background - Concord Hospital
 Integrated Cerner Solutions
– Closed loop medication solution – Inpatient
 Electronic pre...
Future - Concord Hospital
 Integrated Cerner Solutions
– Closed loop medication solution – Inpatient + Discharge/Outpatie...
The User’s Perspective
Swallow whole
EMM Systems
 Home grown versus commercial eMM systems
– Number of home grown systems is decreasing
– Complexity
– Need fo...
Best Way to Customise - What’s the Evidence?
 Limited evidence in the literature
– Health Information Technology: An Upda...
– Failure to utilize functions of an electronic prescribing system and
the subsequent generation of 'technically preventab...
Considerations for Design and Customisation
 Usability versus Standardisation
 Patient Safety versus User Convenience
 ...
Medication Orderables
 Hide some medication orderables
– Generic/franchise brand products which contain the
drug name (Ch...
Order Sentences
 Limit to ten sentences for selection
 Display sequence and grouping
– Common route displayed at the top...
Medication Reconciliation
 Documenting medication history using generic and brands
 Use of “information only” order sent...
Rules and Alerts
 Clinical decision support
– Consolidate clinical information and alert clinicians
– Customisation of Mu...
Clinical Implications
 New errors introduced by the eMM system1
– Selection / ‘click’ errors – MySearch functionality
– E...
Clinician Requests for Design Changes
 Apply principles of eMM design and customisation
– Balance of convenience versus p...
Connie Lo, eMR Clinical Application Specialist, Concord Repatriation Hospital, NSW Health - eMM System Design Consideratio...
Connie Lo, eMR Clinical Application Specialist, Concord Repatriation Hospital, NSW Health - eMM System Design Consideratio...
Connie Lo, eMR Clinical Application Specialist, Concord Repatriation Hospital, NSW Health - eMM System Design Consideratio...
Connie Lo, eMR Clinical Application Specialist, Concord Repatriation Hospital, NSW Health - eMM System Design Consideratio...
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Connie Lo, eMR Clinical Application Specialist, Concord Repatriation Hospital, NSW Health - eMM System Design Considerations for the Clinician-System Interface

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Connie Lo delivered this presentation at the 3rd Annual Electronic Medication Management Conference 2014. This conference is the nation’s only event to look solely at electronic prescribing and electronic medication management systems.

For more information, please visit http://www.healthcareconferences.com.au/emed14

Published in: Health & Medicine
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Connie Lo, eMR Clinical Application Specialist, Concord Repatriation Hospital, NSW Health - eMM System Design Considerations for the Clinician-System Interface

  1. 1. EMM System Design Considerations For The Clinician-System Interface Connie Lo eMM Application Specialist Michael Turner eMM Project Pharmacist Rosemary Richman eMR Project Manager Information Management and Technology Division Sydney and South Western Sydney LHDs
  2. 2. Background - Concord Hospital  Integrated Cerner Solutions – Closed loop medication solution – Inpatient  Electronic prescribing – PowerOrders  Pharmacy review, verification & dispensing – PharmNet  Charting Administration - MAR  Drug database – Multum  Customised Decision Support – Discern Rules
  3. 3. Future - Concord Hospital  Integrated Cerner Solutions – Closed loop medication solution – Inpatient + Discharge/Outpatient  Electronic prescribing – PowerOrders  Pharmacy review, verification & dispensing – PharmNet  Charting Administration - MAR  Drug database – Multum  Customised Decision Support – Discern Rules + more rules  Medication reconciliation  discharge referral  Dispensing system interface – PharmNet to iPharmacy  IV enhancement
  4. 4. The User’s Perspective Swallow whole
  5. 5. EMM Systems  Home grown versus commercial eMM systems – Number of home grown systems is decreasing – Complexity – Need for interfacing/integration (local, state & national level)  Hard coded versus customisable functionality – Core functionality – Standardisation
  6. 6. Best Way to Customise - What’s the Evidence?  Limited evidence in the literature – Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use1 Strong evidence for use of CPOE and CDS however the studies lack detail on system design and build for both successful and unsuccessful aspects of implementations – The Impact of CPOE Medication Systems’ Design Aspects on Usability, Workflow and Medication Orders2 Study found that many different methods had been used to assess different system designs. Design elements were reported as either positive or negative against three categories, ease of use, work flow, and the effect on the medication order. 1. Jones et al. Ann Intern Med. 2014;160: 48-54 2. Khajouei et al. Methods Inf Med 2010; 49: 3-19
  7. 7. – Failure to utilize functions of an electronic prescribing system and the subsequent generation of 'technically preventable' computerized alerts3 – When 'technically preventable' alerts occur, the design-not the prescriber-has failed4 Design is more important than training in ensure the user uses the system correctly. System design that doesn’t account for human factors, may fail to achieve the desired outcomes and may lead to unintended consequences. 3. Baysari et al. J Am Med Inform Assoc 2012;19:1003-1 4. Russ et al. J Am Med Inform Assoc 2012;19:1119 Best Way to Customise - What’s the Evidence?
  8. 8. Considerations for Design and Customisation  Usability versus Standardisation  Patient Safety versus User Convenience  Desirability versus Maintenance  Computerising paper processes versus adopting electronic processes  Consistency  User friendliness and intuitiveness
  9. 9. Medication Orderables  Hide some medication orderables – Generic/franchise brand products which contain the drug name (Chemist’s Own, APO, Genrx) – Metformin (Genrx) – Products which are generally ordered by brand name – allantoin/chlorhexidine/hexamidine topical powder (Medipulv topical powder)
  10. 10. Order Sentences  Limit to ten sentences for selection  Display sequence and grouping – Common route displayed at the top – Lowest dose to highest dose – Sort by dosage form, strength, route, frequency  Use of “information only” order sentences to guide selection + Discern rule to prevent inadvertent selection – Anti-venoms, medication reconciliation
  11. 11. Medication Reconciliation  Documenting medication history using generic and brands  Use of “information only” order sentences to guide selection
  12. 12. Rules and Alerts  Clinical decision support – Consolidate clinical information and alert clinicians – Customisation of Multum drug-drug interactions – Digoxin ADE with abnormal electrolyte results – Cumulative paracetamol dose  ‘Not so clinical’ decision support – Enforce or prevent incorrect workflow – Warfarin/INR check, weekend warfarin ordering – Antibiotic start date-time – Incorrect selection of an ‘information only’ order sentence
  13. 13. Clinical Implications  New errors introduced by the eMM system1 – Selection / ‘click’ errors – MySearch functionality – Editing errors – Route locked on order modification – New tasks introduced by eMM system – Ordering reminders – patch/patch removals - rules – Default date/times - rules  Automation - safety versus convenience – Default values / auto-population – Lessons from aviation 5. Westbrook et al J Am Med Inform Assoc 2013; 20: 1159-1167
  14. 14. Clinician Requests for Design Changes  Apply principles of eMM design and customisation – Balance of convenience versus patient safety – Balance of desirability versus ongoing system maintenance  Consider impact on other applications within the EMR – Shared drop down lists  Consider flow on effects of requested change

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